Medical-related matters dominated the brief agendas at the morning and afternoon sessions of the Kern County Board of Supervisors on Tuesday.

The matters included an ambulatory surgery center facility, temporary hospital closures for emergency patients, ambulance fees and a fine for operation of a medical marijuana facility.

Supervisors voted 5-0 to approve the selection of Rio Bravo Medical Campus LLC to develop a free-standing ambulatory surgery center, Earnhart & Associates to provide management for the daily operations of the facility, and the chief executive officer of Kern Medical Center to develop a facility lease agreement with Rio Bravo and a management services agreement with Earnhart.

In September, KMC issued a request for proposal seeking a long-term lease for a “turnkey” ambulatory surgery center, Paul J. Hensler, the hospital’s CEO, told the supervisors. The facility – which will be opened in 18 to 24 months -- will attract new income for KMC to bring the hospital out of the red.

The Medical Campus will be on 46 acres and include a retirement/care facility and the more-than-15,000-square-foot surgery center. It will generate 400 permanent jobs, county staff reported.

But the vote didn’t come until after a spokesman for a losing vendor for the project asked supervisors to delay their vote until the board’s March 19 meeting, when additional information could be presented on his company’s bid.

Officials with Rio Bravo and Earnhart spoke in favor of their bid, which county staff had selected. County staff presented information on the project, including why they made their recommendation.

The spokesman for the losing bidder said his company can offer a location a mile from KMC while the Rio Bravo plan is 4.5 miles away, and would be at a lower rent and they would have their facility up and running in 12 months.

But the winning vendor noted that the other bid favored a site in a “strip mall” with a limit on growth, and that the vendor’s rent estimate didn’t cover all associated costs.

“We followed all of the rules and met all the requirements,” said Gary Bruno, speaking in behalf of Rio Bravo. The Rio Bravo facility will attract higher income people who now often go out of the area for medical care, while also serving those who are uninsured and/or lower income who now make up the bulk of KMC patients, Bruno said.

“Hospital closure is a term used to describe the practice of diverting ambulances away from a hospital emergency department for a defined period of time,” Matthew Constantine, county director of Public health Services, told the board in a letter.

“Closure has been a long-standing practice in the Metro Bakersfield area. The closure policy only affects ambulance traffic, at no time is a hospital emergency department closed to walk-in traffic by the public.”

For areas such as Ridgecrest and Tehachapi – where there is only one hospital – “closure has never been an option,” Constantine said.

“Six hospitals are located in the Metro Bakersfield area so closure to ambulance traffic became a common practice, with at least four hospitals always available at any given time.”

With closure, patient choice is limited and it might impact insurance coverage, said 3rd District Supervisor Mike Maggard, the board chairman.

“Insurance may not cover that hospital, their doctor may not be able to provide care, they may need a second ambulance move,” Maggard said. “Diversion doesn’t solve hospital overcrowding problems.”

The revisions approved by the supervisors would force the hospitals to take action to see that – except in cases of a true internal disaster such as power outages, flooding, a fire or smoke – there are enough beds available for ambulatory patients’ choice and/or need, staff reported.

“In the past there has been no definition of internal disaster,” Maggard said. “Crowding is not an internal disaster. Hospitals effect patient choice. We need to provide the resources to meet that demand ... Force the issue of meeting the demand.”

Constantine wrote: “There are several studies that describe strategies and actions hospitals can take to reduce emergency department over crowding and solve inpatient bed constraints. There are many resources available to hospitals to learn how to become more proficient at patient throughput.”

Ambulance fees

The five ground ambulance service providers that have exclusive operating areas in Kern County have been granted cost-of-living adjustments rate increases by the board. The five are CARE, Delano, Hall, Kern and Liberty Ambulance services. The item was approved as part of the board’s consent agenda motion.

Hall, Kern and Liberty were eligible for 2011 COLAs, all five were eligible for 2012 COLAs and all but Liberty were eligible for 2013 COLAs, according to Constantine.

Page 3 of 4 - The rate changes cover both basic and advanced life support services for both base and standby. The changes are:

* CARE, base rates up $88 to $1,179 for basic and $1,308 for advanced, and standby rates up $8 per hour to $152 basic and $195 advanced;

* Delano, base rates up $50 to $1,069 for basic and $1,129 for advanced, and standby rates up $6 per hour to $122 basic and $158 advanced;

* Hall, base rates up $141 to $1,139 for basic, $1,315 for advanced and $2,641 for critical care transport, and standby rates up $12 per hour to $137 for basic and $1786 for advanced;

* Kern, base rates up $149 to $1,209 for basic and $1,309 for advanced, and standby rates up $12 per hour to $138 basic and $176 advanced;

* Liberty, base rates up $124 to $1,250 for basic and $1,608 for advanced, and standby rates up $11 per hour to $162 for basic and $206 for advanced.

Fine up in smoke

Supervisors voted 5-0 to waive a $50,000 fine for an ordinance code violation that was levied in November against High Desert Plaza, 16804 Highway 58, and Chronically Inclined Inc., medical marijuana dispensary.

At the time the fine was levied against the property owner and the business owner/operator, the county thought Chronically Inclined was still open for business after being told to close.

But owner Sandra Wood convinced county staff and the board that the business had closed when told.

“Staff and the operators have met ... They want to come into compliance with Kern County rules,” said Charles Lackey, director of county building inspection.

Lackey asked the board to consider a revision on the fine.

“I’m impressed with her professionalism and honesty,” Supervisor Scrivner said. “I move to rescind the $50,000 fine and any other penalties on the owner of the property and on the operator.”

Fourth District Supervisor David Couch asked who had written the hand-lettered sign at the business which “misspelled” supervisors as stupidvisors. Her husband did, Wood said.

Supervisors then voted to rescind the fine on the condition that signs are removed.

Other actions

In other actions, the supervisors:

* In closed session voted to petition the California Supreme Court to uphold the injunction in the suit Los Angeles (city) vs. Kern County, regarding Measure E which prohibited the dumping of sludge in Kern County;

* Approved the purchase of 24 replacement and three new vehicles for an amount not to exceed $547,900;

* Accepted donations to Kern County Library from three Friends of the libraries groups, including $10,000 from Friends of the Ridgecrest Library;

* Approved the expense of up to $10,000 to produce and distribute the 10th edition of Jawbone OHV Trail Map;

* Approved the expense of up to $10,887 to clear downed trees and repair trail tread on Piute Single Track Trail System in Sequoia National Forest;

Page 4 of 4 - * Approved a maximum funding of nearly $8.8 million for the 2012-13 fiscal year for Children’s Medical Services Plan and budgets for Child Health and Disability Prevention program, the Foster Care Program and California Children Services;

* Approved transferring $17,700 from the Sheriff’s Firearms Fund to the purchase of four sniper rifles for the Special Weapons and Tactics Team;

* Approved a resolution of acceptance of a portion of an offer of dedication of a road easement along 60th Street West in Rosamond;

* Approved establishing a 40-mile-per-hour speed limit on about 1,300 feet of Mahan Street between Springer Avenue and China Lake Boulevard in Ridgecrest;

* Accepted a notice of completion with Griffith Co. for construction on Bowman Road from Jacks Ranch Road to Downs Street in Ridgecrest;

* Received a report on emergency sewer lift station repairs at Ridgecrest Fire Station No. 74;

* Approved an amendment to the master license agreement with California Broadband Cooperation Inc. for use of county properties designated as anchor sites for transmitting high-speed, high-capacity broadband communication services, and for use of county rights-of-way for underground fiber optic transmission lines in eastern Kern County;

* Set a hearing for 2 p.m. on Tuesday, April 9, to amend the franchise ordinance regarding Rosamond Two LLC to adjust the franchise area, incorporate new terms and conditions, and allow the franchise to be recorded.